A Novel Tuberculosis Antigen Identified from Human Tuberculosis Granulomas

Tuberculosis is a global infectious disease caused by Mycobacterium tuberculosis (Mtb). Although novel Mtb biomarkers from both the pathogen and host have been studied, more breakthroughs are still needed to meet different clinic requirements. In an effort to identify Mtb antigens, chaperone-peptide complexes were purified from TB infected lungs using free-solution isoelectric focusing combined with high resolution LTQ Orbitrap Velos mass spectrometry. Antigen specific cellular immune responses in vitro were then examined. Those efforts led to the identification of six Mtb peptides only identified in Tuberculosis lung samples and that were not found in the control samples. Additionally, antigen-specific IFN-γ secretion, T-cell proliferation, cytokine expression, and a cytotoxic assay were also evaluated. Among the peptides isolated, we identified a 34 amino acid peptide named PKA_p belonging to a serine/threonine–protein kinase, as being able to generate Mtb-specific cellular immune responses as noted by elevated antigen-specific cytokine secretion levels, increased CD8⁺ T-cell proliferation and a strong cytotoxic lymphocyte (CTL) response. Moreover, the immune stimulating abilities of PKA_p were further validated in vivo, with target peptide immunized mice showing an increased cellular IFN-γ in both the lungs and spleen without causing immunopathogenesis. In conclusion, we identified novel functional Mtb antigens directly from the granulomatous lesions of Tuberculosis patients, inducing not only significant antigen-specific IFN-γ secretion but also a marked cytotoxic lymphocyte functional response. These findings indicated that PKA_p has potential as a novel antigen biomarker for vaccine development.Mycobacterium tuberculosis (Mtb),¹ the infectious agent that causes tuberculosis, is associated with an estimated 1.4 million deaths per year and remains a major global health concern (1). Current research and diagnostics have focused on antigen screening and biomarker discovery, with most antigen screening methods focused on the bacterial pathogen itself, with less focus on the Mtb infected host (2). The pathogenic progression of TB occurs in the lungs, making the characterization of any functional antigens existing in the lungs during infection potentially useful for immunotherapy or vaccine development. The immune response to an Mtb infection results in the formation of a granuloma that initially contains bacterial expansion, but may fail to eliminate the pathogen (3, 4). This immune response brings with the possibility of identifying Mtb functional antigens in the lung tissue and to gain a clearer understanding of the immune mechanisms (5, 6). Although it has been well studied that a T-cell mediated adaptive immune response plays a central role during Mtb infection and is crucial in both protection and pathogenesis, a better understanding of the antigen induced immune response and correlations to pathogenicity is necessary (2, 7).It has been reported that heat shock proteins (such as the HSP70 family members) and others chaperones such as Gp96 can specifically bind many hydrophobic sequences, enabling them to bind foreign peptides associated with intracellular bacterial or viral challenge (8), such as Gp96 associating with a HBV-specific peptide (9). Previous studies have shown that chaperone-peptide complexes can induce a disease-specific immune response (10–12), with the gp96-peptide complex from H37Rv infected cells able to induce a protective antigen specific immune response (13). Currently, no Mtb chaperone-associated peptides have been isolated directly from patients, thus the present study explores the possible existence of these complexes in TB lung tissue.To achieve this objective, the free-solution isoelectric focusing (FS-IEF) technique, which has been reported to enrich chaperones in cell lysates or tissue samples, was combined with Linear Trap Quadrupole (LTQ) OrbitrapVelos mass spectrometry, which was used to identify the associated Mtb peptides. Using these techniques, we obtained chaperone-rich cell lysates from the granulomatous lung lesions of active TB patients and identified six Mtb-associated peptides not noted in the control samples. Among them, a peptide (PKA_p) derived from Mtb Protein Kinase A not only contributed to significant antigen-specific IFN-γ secretion, but also contributed to CTL function and T-cell proliferation. Importantly, murine immunization with PKA_p derived peptides elicited an antigen-specific cellular activation without the occurrence of immune pathogenesis.     

A Comparative Study of Mycobacteria from Patients' Room Dusts and from Sputa of Tuberculous Patients

The source of mycobacteria other than Mycobacterium tuberculosis occurring in sputa of tuberculous patients as casual isolates was investigated by comparing the occurrence rate of mycobacterial species between patient's room dust and patient's sputum. Almost all species of mycobacteria recovered from sputa could be found in dusts obtained from the rooms. However, the percentage of occurrence of the mycobacterial species in dusts differed from that in sputa. In dusts, Mycobacterium fortuitum (39.6%), Mycobacterium nonchromogenicum (23.5%) and Mycobacterium gordonae (16.7%) occurred in high frequencies, whereas Mycobacterium intracellulare (69.6%), M. gordonae (5.9%), Mycobacterium scrofulaceum (5.2%), and Gordona bronchialis (10.4%) were the main species found in sputa. The patterns of occurrence of mycobacterial species as illustrated above may suggest that pathogenic mycobacteria survive in the respiratory tract while nonpathogenic ones are destroyed there, thus the human body acts as a selective medium for the pathogenic mycobacterial species. Serotype studies on strains of M. intracellular as casual isolates indicated that those from sputa of tuberculous patients were different from those derived from patients with lung diseases due to this species of mycobacteria. These results led us to the conclusion that mycobacteria in patients' room dusts were the source of mycobacteria occurring in sputa as casual isolates, particularly the pathogenic mycobacteria in dusts are more likely to survive in the human respiratory tract, occasionally multiplying and causing disease under favorable circumstances.     

Direct Fluorescent-Antibody Method for the Diagnosis of Pneumocystis carinii Pneumonitis from Sputa or Tracheal Aspirates from Humans

A direct fluorescent antibody (DFA) method was applied to sputum or tracheal aspirate from 68 patients with clinical or radiological evidence suggesting Pneumocystis carinii pneumonitis, and to 50 control patients. P. carinii was detected by DFA in specimens from 33 of the 69 clinical cases and 3 of the 50 controls. Specimens of lung from 11 of 33 DFA-positive cases were examined histologically, and 9 were positive. Four of 35 DFA-negative cases were examined histologically, and all were negative. Sputa or tracheal aspirates from 6 patients who were positive by both DFA and histological examination were examined also by methenamine silver staining; none could be diagnosed conclusively by this method. The results indicate that the DFA method is a sensitive and dependable procedure for the laboratory diagnosis of P. carinii pneumonitis in man.     

Standardization of Human Diploid Cell Cultivation

Human embryonic diploid lung fibroblasts grown in Eagle's medium were exposed continually to a variety of environmental conditions over a large number of passages to observe how these conditions affected the growth and longevity of these cells in vitro. The cells grew well at temperatures between 34 and 37 C and some cells could be adapted to grow at 40 C. Very limited growth occurred at 30 to 31 C; however, confluent monolayers of cells could be maintained for months at 30 C and still give rise to actively growing cultures. Increasing the amino acid concentration in Eagle's medium or the calf serum concentration above 10% had no effect on the growth rate or longevity. One per cent calf serum could not support prolonged active growth. Trypsin concentrations between 1 and 0.1% and crystalline trypsin at 50 μg/ml showed no influence on cell growth. Ethylenediaminetetraacetic acid treatment and scraping, however, destroyed many of the cells, and the survivors grew poorly. The clonal morphology varied with age. Young cells frequently gave rise to densely packed clones, whereas older cells gave rise to clones with widely scattered cells. The cloning efficiency was high when the cells were young but decreased rapidly with successive passage. It was relatively constant from the 7th to 20th passage at about 15%.     

Tuberculosis chemoprophylaxis.

The incidence of tuberculosis in the United States, after decreasing for many years, has recently begun to climb at an alarming rate. This rise is due mainly to excess cases in high-risk groups including human immunodeficiency virus-infected patients, the elderly, the foreign born, and the homeless. In the United States tuberculosis has been associated with a 10% mortality despite adequate treatment. The tuberculin skin test is a safe and inexpensive test for detecting tuberculous infection. To improve its predictive value the diagnostic criteria for classifying a positive reaction have recently been revised. High-risk populations should be screened to identify those persons who would most benefit from preventive treatment. Isoniazid therapy taken for 6 to 12 months is a safe and highly effective means of preventing tuberculous infection from developing into active disease. The most worrisome toxicity of isoniazid, fatal hepatitis, is extremely rare; when patients are monitored closely the incidence of death from hepatotoxicity is less than 0.01%.     

人MIF基因启动子多态性与结核病易感性的关系

为了研究巨噬细胞移动抑制因子(MIF)与结核病易感性的关系,分析了肺结核病人和正常人MIF基因启动子多态性。DNA测序分析的结果显示,正常人MIF基因启动子-794区CATT序列重复次数存在明显的差异,5、6和7个拷贝的几率分别是22.2%、44.4%和33.3%。7个肺结核病人中6人有6个拷贝,1人有7个拷贝,出现的频率分别为85.6%和14.3%。对比分析提示,肺结核病人MIF基因启动子区CATT低拷贝数(低于或等于6个)出现的频率明显高于正常人(85.6%比66.6%),可能同结核病的致病相关。